What are the exact criteria that must be met for Lactational Amenorrhea Method (LAM) to be considered effective as birth control? How frequently must I be breastfeeding, for how long each time, and for what specific durations throughout the day and night? Does the effectiveness change depending on the infant’s age, and if so, how? What happens if I supplement with formula or pumped milk, even occasionally? Does the introduction of solid foods affect the reliability of LAM? What other forms of contraception are safe and effective to use alongside breastfeeding, and when should I consider transitioning to one of those methods? Also, what are the statistics regarding LAM failure rates, both typical and perfect use, and how do those compare to other common birth control methods like the pill, IUD, or condoms?

Answer

Is breastfeeding reliable birth control?

Breastfeeding can be an effective method of temporary birth control, but it’s not foolproof. It relies on a specific set of conditions being met, known as the Lactational Amenorrhea Method (LAM). When those conditions aren’t met, the risk of pregnancy increases significantly.

What is the Lactational Amenorrhea Method (LAM)?

LAM is a temporary birth control method that relies on the natural hormonal suppression of ovulation that can occur during breastfeeding. It works best when:

• Your baby is under six months old: After six months, babies typically start needing supplemental foods, which reduces breastfeeding frequency and duration.
• You are exclusively breastfeeding (or nearly exclusively): This means your baby is receiving all or almost all of their nutrition from breastfeeding. Supplemental feedings, formula, or solid foods decrease the frequency and intensity of sucking, reducing the hormonal effect that suppresses ovulation. "Exclusively" usually means no more than occasional small amounts of other food or liquids.
• Your menstrual periods haven’t returned: The return of menstruation indicates that ovulation is likely resuming, making pregnancy possible again.

When these three conditions are met, LAM can be more than 98% effective in preventing pregnancy.

How does breastfeeding prevent pregnancy?

Frequent and intense suckling by the baby stimulates the release of prolactin, a hormone that promotes milk production. High prolactin levels can interfere with the release of gonadotropin-releasing hormone (GnRH), which is essential for the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. LH and FSH are crucial for ovulation. By suppressing GnRH, LH, and FSH, ovulation is inhibited, thus preventing pregnancy.

When does LAM stop being effective?

LAM ceases to be reliable birth control when any of the three conditions are no longer met:

• When the baby turns six months old.
• When supplemental feedings are introduced regularly.
• When menstrual periods return.

Even spotting may indicate a return to fertility, and a barrier method is advisable.

What are the risks of relying on breastfeeding as birth control?

The primary risk is unintended pregnancy. If the criteria for LAM aren’t strictly followed, or if ovulation resumes unexpectedly, pregnancy can occur. The effectiveness of LAM decreases significantly when supplements are introduced or when breastfeeding frequency decreases.

What are the benefits of breastfeeding as birth control?

• Natural and hormone-free: LAM doesn’t involve artificial hormones or devices.
• Convenient and readily available (initially): It’s a built-in method for breastfeeding mothers.
• Cost-effective: Breastfeeding is generally less expensive than formula feeding.
• Health benefits for both mother and baby: Breastfeeding provides numerous nutritional and immunological benefits for the baby, and it can help the mother’s uterus contract back to its pre-pregnancy size, reduce the risk of certain cancers, and promote postpartum weight loss (although weight loss varies among individuals).

How do I know if LAM is working for me?

Strictly adhere to the three criteria: baby under six months, exclusive breastfeeding, and no return of menstruation. If any of these conditions change, LAM is no longer reliable. If you are unsure, use an alternative method of contraception.

What should I do if I want to continue breastfeeding but need reliable birth control?

Once LAM is no longer effective, consider alternative birth control methods that are compatible with breastfeeding. Some options include:

• Progestin-only birth control pills (mini-pills): These are generally considered safe for breastfeeding mothers and don’t typically affect milk supply.
• Progestin-only injections (Depo-Provera): These are also safe for breastfeeding and last for three months.
• Progestin implants (Nexplanon): A long-acting, reversible contraceptive (LARC) that’s safe for breastfeeding.
• Intrauterine devices (IUDs): Both hormonal (levonorgestrel-releasing) and copper IUDs are safe for breastfeeding. Insertion can sometimes be uncomfortable immediately postpartum, so discuss timing with your healthcare provider.
• Barrier methods (condoms, diaphragms, cervical caps): These are hormone-free options.
• Spermicides: Can be used with barrier methods.
• Natural Family Planning/Fertility Awareness-Based Methods: These methods can be more challenging to use effectively while breastfeeding due to hormonal fluctuations.

Are all birth control methods safe to use while breastfeeding?

Most birth control methods are considered safe for breastfeeding, but it’s always best to consult with your healthcare provider. Estrogen-containing birth control pills are generally not recommended during breastfeeding, especially in the early months, as they can potentially reduce milk supply. Progestin-only methods are preferred.

When should I start using another form of birth control after giving birth if I’m breastfeeding?

Discuss this with your healthcare provider. Some women start using another method as early as three weeks postpartum. If you are planning on relying on LAM, be aware that it will only be effective if ALL criteria are met. It is important to have an alternative plan in place before any of the criteria for LAM are no longer met.

Can I get pregnant while breastfeeding even if I haven’t had my period yet?

Yes. Ovulation precedes menstruation. You can ovulate before your period returns, meaning you could become pregnant before you even know your period is coming back.

Does pumping breast milk provide the same contraceptive effect as direct breastfeeding?

Pumping can provide some of the same hormonal effects as direct breastfeeding, but it’s generally considered less effective for contraception. The frequency and intensity of suckling are key to suppressing ovulation. A baby suckling directly at the breast often provides more consistent and intense stimulation than pumping. It is also more difficult to maintain the exclusivity criteria when pumping.

Where can I get more information?

Consult with your doctor, midwife, or a lactation consultant for personalized advice on breastfeeding and contraception. You can also find reliable information from organizations such as the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and La Leche League International.